Health Estimates
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Health Estimates Newswire

Oct. 18, 2018: HHS Working On New Rules That Would Impact ACA Exchanges, Medicaid, FDA Guidelines

HHS Working On New Rules That Would Impact ACA Exchanges, Medicaid, FDA Guidelines.

Congressional Quarterly  (10/17, Siddons, Clason, Williams, Subscription Publication) reports that the Trump Administration intends “to pursue regulatory changes in the next year that could affect health care insurance exchanges, patient privacy, Medicaid coverage and food labeling.” On Wednesday, the Office of Management and Budget published a “unified agenda” which “included 188 Health and Human Services Department rules that are administration priorities. Most are in the early stages of rulemaking, which involves soliciting public comments on initial proposals,” however, “some are in the final stages and could be released soon.” The article says one proposal would “update Medicaid’s drug rebate program to include regulations that promote value-based purchasing arrangements with pharmaceutical companies.” HHS Secretary Alex Azar “strongly supports such agreements, which could produce extra rebates for states if drugs do not achieve certain clinical outcomes.” The piece adds that the FDA also aims “to advance rules that could make it easier for drug companies to seek approval of generic versions of pricey biotech drugs.”

Legislation and Policy

McConnell Says Republicans Could Try To Repeal The ACA Again Next Year.

Reuters  (10/17, Morgan) reports that Senate Majority Leader Mitch McConnell said today that Republicans “could try again to repeal Obamacare if they win enough seats in U.S. elections next month...calling a failed 2017 push to repeal” the Affordable Care Act “the one disappointment of this Congress from a Republican point of view.” McConnell said, “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks. ... We’re not satisfied with the way Obamacare is working.”

CMS Aims To Streamline Medicaid Managed Care Rules.

Congressional Quarterly  (10/17, Williams, Subscription Publication) reports Jim Parker, a senior adviser to HHS Secretary Alex Azar, “said the Trump administration is focused on ways to reduce federal regulatory burdens as it works to overhaul an Obama-era rule overseeing Medicaid’s massive managed care system.” Parker, who also heads the Office of Health Reform, said CMS has made “significant progress” in reviewing the 2016 managed care rule and said the agency wants to “support state flexibility,” but did he not specify the changes CMS plans to make.

Public Health and Private Healthcare Systems

Trump Administration’s Approval Of Waivers For Reinsurance Programs Helping To Lower ACA Premiums.

Paige Winfield Cunningham writes in the Washington Post  (10/17) “The Health 202” blog that the Trump Administration has been criticized “for trying to sabotage Obamacare,” however, “there’s a key way it has been working behind the scenes to lower health insurance premiums.” She says several “states have obtained permission from the Centers for Medicare and Medicaid Services to divert some federal dollars from insurance subsidies to what’s known as reinsurance, which you could think of as insurance for insurers. Reinsurance programs help insurers cover the costs for their most expensive patients, thus allowing them to lower overall monthly premiums for everyone.” Cunningham adds that CMS Administrator Seema Verma has been approving “the waivers at a rapid pace.”

Most ACOs To Remain In MSSP Despite Downside Risk, Survey Finds.

Modern Healthcare  (10/17, Dickson, Subscription Publication) reports a new survey by the National Association of ACOs indicates nearly 50 percent of ACOs plan to participate in the Medicare Shared Savings Program (MSSP) if CMS restructures it and “eliminates some tracks that don’t include financial risks for the organizations.” Those figures mark a “stark change from this spring, when 71% of early MSSP adopters said that they were likely to leave the program if forced to take on more risk.” Currently “only 36% say they’ll likely exit the program, and 16% are neutral on their future commitment.”

States Move To Require Insurance Coverage For Younger Cancer Patients’ Fertility Preservation.

Kaiser Health News  (10/17, Andrews) reports that because the “question of fertility is often overlooked when young cancer patients are battling a life-threatening illness,” and health insurance generally does not cover fertility preservation care so the process can be cost-prohibitive for patients, “a growing number of states now require plans to cover such services when medically necessary treatment jeopardizes fertility.” Currently, 16 states “require insurers to offer or cover infertility services to some extent, according to infertility advocacy organization Resolve”; and efforts are underway in New Jersey and New York to introduce such coverage.

CVS-Aetna Merger Approved By Connecticut Insurance Regulators.

The Connecticut Mirror  (10/17, Rigg) reports, “The Connecticut Insurance Department has approved CVS Health Corp.’s $69 billion merger with Hartford-based Aetna Inc.,” with the approval “contingent” upon “Aetna completing the sale of its entire standalone Medicare Part D prescription plan business to a subsidiary of WellCare Health Plans, according to the insurance department’s decision issued” on Oct. 17. The Hartford (CT) Business Journal  (10/17, Pilon) also covers the story.

Japsen: UnitedHealth Group Spent Nearly Half Of Annual Reimbursements On Value-Based Care.

Forbes  (10/17) contributor Bruce Japsen writes that UnitedHealth Group released data “on its value-based care efforts during this week’s third-quarter earnings call.” Japsen says the company spent nearly half of its yearly reimbursements, which amount to $69 billion, on value-based care, “replacing fee-for-service medicine in the U.S.” Dan Schumacher, “president and chief operating officer of UnitedHealth’s UnitedHealthcare business,” says the company has a goal to increase that amount to $75 billion by 2020. Japsen adds that other insurers, as well as Medicare and Medicaid, are also shifting away from fee-for-service medicine.

Kansas Gubernatorial Candidate Proposes Work Restrictions On Medicaid, SNAP, TANF.

The Topeka (KS) Capital-Journal  (10/17, Carpenter) reports Kansas Republican gubernatorial candidate Kris Kobach revealed Wednesday “proposals to impose work requirements, drug testing and immigration requirements for participation by Kansans in Medicaid” and the SNAP and TANF programs. Kobach “said the objective of his welfare reform would be to convince ‘able-bodied’ adults without children to join the workforce in Kansas, which had an unemployment rate of 3.3 percent in August.”


California May Not Be Able To Further Reduce The Number Of Uninsured Residents, Experts Say.

The Sacramento (CA) Bee  (10/17, Finch) reports that following “a streak of steady declines, California’s uninsured rate bottomed out last year with some 2.7 million people still without health coverage.” The latest data from the Census Bureau “offer a fragmented portrait of the remaining people who are uninsured while posing an even bigger question for the state: How much lower can the uninsured rate go?” The article adds that as the open enrollment period gets underway, “health care experts say it will be difficult for the state to move forward, largely because of California’s population of immigrants who don’t qualify for Affordable Care Act plans.”

Jeff Sopko